The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand
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Concerns about the long-term sustainability of health care expenditures (HCEs), particularly prescribing expenditures, has become an important policy issue in most developed countries. Previous studies suggest that proximity to death (PTD) has a significant effect on total HCEs, with its exclusion leading to an overestimation of likely growth. There are limited studies of pharmaceutical expenditures in which PTD is taken into account.
This study presents an empirical analysis of public medication expenditure on older individuals in New Zealand (NZ). The aim of the study was to examine the individual effects of age and PTD using individual-level data.
This study uses individual-level dispensing data from 2008/2009 covering the whole population of medication users aged 70 years or older and resident in NZ. A case–control methodology was used to examine individual cost and medication use for a 12-month period for decedents (cases) and survivors (controls). A random effects two-part model, with a Probit and generalized linear model (GLM) was used to explore the effect of age and PTD on expenditures.
The impact of PTD on prescription expenditure is not as dramatic as studies reporting on acute and/or long-term care. The 12-month decedent-to-survivor mean expenditure ratio was 1.95; 2.09 for males and 1.82 for females. The additional cost of dying in terms of prescription drugs decreases with age, with those who die at 90 years of age or older consuming fewer drugs on average and having a lower mean expenditure than those who died in their 70s and 80s. The following variables were found to have a decreasing effect on the mean monthly prescription expenditures: a reduction of 2.2 % for each additional year of age, 4.2 % being in the Maori ethnic group, and 7.8 % for Pacific Islanders. Increases in monthly expenditure were associated with being a decedent 32.1–62.6 % (depending on month), being of Asian origin 16.2 %, or being a male 12.6 %.
Given the variance reported between survivors and decedents, future projections should include PTD in their models to improve accuracy. Policies targeted at reducing expenditures should not focus on age but on ensuring appropriate and cost-effective prescribing, particularly towards the end of life.
KeywordsHealth Care Expenditure Monthly Expenditure Total Health Care Cost Total Health Care Expenditure Coarsen Exact Match
Data were provided by the Ministry of Health New Zealand. The initial database was set up using facilities provided by the Trinity Centre for High Performance Computing, which is funded through grants from the Science Foundation Ireland. Patrick V. Moore is funded by the Health Research Board in Ireland (HRB PhD Scholars Programme in Health Services Research) under grant no. PHD/2007/16.
Conflicts of interest
No conflicts to be declared.
Patrick V. Moore designed the study, conducted the data analysis and prepared the manuscript. Kathleen Bennett was involved in the study design and preparation of the manuscript. Charles Normand was involved in the study design and review of the manuscript. All authors performed a critical review of the manuscript content and approved its final version. Patrick V. Moore acts as guarantor of the overall content of this article.
- 1.Statistics New Zealand. National population projections: 2009 (base)–2061. Wellington: Statistics New Zealand. 2009. Available from: http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/NationalPopulationProjections_HOTP09base-61.aspx. Accessed 27 Oct 2012.
- 2.Labour force statistics: population projections, OECD employment and labour market statistics (database). 2011. Available from: http://www.oecd-ilibrary.org/employment/data/labour-force-statistics/historical-population-data-and-projections_data-00538-en;jsessionid=ba3jrdodrsu7f.delta?isPartOf=/content/datacollection/lfs-lfs-data-en. Accessed 21 May 2013.
- 3.World population prospects: the 2012 revision. United Nations. 2013. Available from: http://esa.un.org/unpd/wpp/index.htm. Accessed 1 Oct 2013.
- 6.Fuchs VR. “Though much is taken”: reflections on ageing, health and medical care. Milbank Mem Fund Q Health Soc. 1984;61(1):143–66.Google Scholar
- 11.Seshamani M, Gray AM. A longitudinal study of the effects of age and time to death on hospital costs. J Health Econ. 2004;23(2):217–35.Google Scholar
- 15.Healthdata. Organisation for Economic Co-operation and Development. 2013. Accessed 30 Sep 2013.Google Scholar
- 18.OECD. Health at a glance 2011: OECD indicators. 2011. Available from: http://www.oecd.org/els/health-systems/health-at-a-glance.htm.
- 25.Duan N, Manning WG, Morris CN, Newhouse JP. A comparison of alternative models of the demand for medical care. J Bus Econ Stat. 1983;1(2):115–26.Google Scholar
- 26.Jones AM. Health econometrics. In: Culyer A, Newhouse J, editors. Handbook of health economics. Amsterdam: Elsevier; 2000.Google Scholar
- 27.Akaike H. Information theory and an extension of the maximum likelihood principle. In: Petrov BN, Csaki F, editors. Second international symposium on information theory. Budapest: Akademiai Kiado; 1973: pp. 267–281.Google Scholar
- 36.Blakely T, Fawcett J, Atkinson J, Tobias M, Cheung J. Decades of disparity II: socioeconomic mortality trends in New Zealand, 1981–1999. Wellington: Ministry of Health; 2005.Google Scholar
- 37.Ministry of health. Tatau Kura Tangata: Health of Older Maori Chart Book 2011 Wellington: Ministry of Health (NZ); 2011.Google Scholar
- 38.McNaughton H, Weatherall M, McPherson K, Taylor W, Harwood M. The comparability of resource utilisation for Europeans and non-Europeans following stroke in New Zealand. NZ Med J. 2002;115(1149):101–3.Google Scholar
- 42.Statistics New Zealand. New Zealand period life tables: 2010–12. Wellington: Statistics New Zealand; 2013. Available from: http://www.stats.govt.nz/browse_for_stats/health/life_expectancy/NZLifeTables_HOTP10-12.aspx. Accessed 20 Apr 2013.
- 47.Statistics New Zealand. National population estimates 2008. Wellington: Statistics New Zealand; 2011. Available from: http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/national-pop-estimates.aspx. Accessed 21 Jun 2011.